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Links between pancreatitis and pancreatic cancer

What is pancreatitis?

Pancreatitis means inflammation of the pancreas. Pancreatitis used as a general term can be a little bit confusing, especially in relation to pancreatic cancer, because it covers several distinct conditions which each have a very different relationship to pancreatic cancer. These conditions are called:

Acute Pancreatitis

Acute pancreatitis is inflammation of the pancreas that comes on suddenly, usually in people who haven’t had any form of pancreatitis before. A few people can have a second or even recurrent episodes of acute pancreatitis, but this is different from chronic pancreatitis.

8 out of 10 attacks of acute pancreatitis are triggered by excess alcohol consumption or gallstones

Symptoms of acute pancreatitis

Severe pain in the centre of the tummy, which may go through to the back, that comes on suddenly over a few minutes to several hours

Nausea (feeling sick) and/or Vomiting (being sick).

Most people are unwell enough to need admission to hospital straightaway. The diagnosis of acute pancreatitis is made if someone has those symptoms and has a positive blood test for one of the pancreas enzymes (called amylase or lipase). Occasionally the diagnosis is not clear and is made after a CT scan of the abdomen is done. There are unfortunately no specific medicines that can halt acute pancreatitis or prevent it from occurring.

How is acute pancreatitis linked to pancreatic cancer?

We don’t think that acute pancreatitis in itself is a direct risk factor for pancreatic cancer. However, the two conditions are certainly linked in the following ways:

Pancreatic cancer tumours can block the narrow tube running in the middle of the pancreas (the pancreatic duct), which can trigger an attack of acute pancreatitis. This means that occasionally, the first sign that someone has pancreas cancer is that they have an attack of acute pancreatitis. This possibly explains the observations that people with a new diagnosis of pancreas cancer have had an attack of pancreatitis in the year or two prior to their diagnosis.

Radiotherapy to the pancreas given as part of treatment for pancreas cancer can trigger acute pancreatitis

Endoscopic ultrasound, especially with biopsy of the pancreas done to evaluate a suspected pancreas cancer can trigger an attack of acute pancreatitis.

ERCP (an endoscopy test) to place a stent in the bile duct to unblock it to relieve jaundice, can trigger acute pancreatitis.

Occasionally, operations on the pancreas to remove tumours can trigger acute pancreatitis in the remaining part of the pancreas.

Chronic pancreatitis

Chronic pancreatitis is long-term inflammation. This long-term inflammation causes scarring of the pancreas, which can cause gnawing severe pain in the centre of your tummy and/or going through to your back.

Because the pancreas tissue that is necessary for digesting food is gradually destroyed by this condition, and replaced by scar tissue, people with chronic pancreatitis can develop malabsorption. (Malabsorption is a condition in which there is a difficulty digesting or absorbing nutrients from food.) The insulin-producing cells are embedded in the pancreas and, if the scarring is extensive, pancreatic function is impaired and diabetes can also occur.

Most people with chronic pancreatitis are, or were, heavy drinkers of alcohol, and/or heavy smokers. Some long-term medicines are thought to be associated with chronic pancreatitis, for example certain epilepsy medicines.

Symptoms of chronic pancreatitis

Chronic pancreatitis presents many symptoms similar to pancreatic cancer, including:

Severe tummy pain or digestion problems. These are progressive episodes that happen frequently and are quite severe. Mild pain between the episodes can also be experienced, particularly in people that continue to drink alcohol.

Because of the similarities between the symptoms of chronic pancreatitis and pancreatic cancer, it can be difficult to make the distinction without specialist input, a CT scan (which often needs repeated at an interval of several months) and occasionally an endoscopic ultrasound test, which can involve a biopsy.

How is chronic pancreatitis linked to pancreatic cancer?

Chronic pancreatitis is a risk factor for pancreatic cancer, increasing the risk of pancreatic cancer by 2 to 3 times that of the general population. However, smoking is a risk factor for both pancreatic cancer and chronic pancreatitis, so the relationship between the two is not completely clear.

Furthermore, a pancreatic cancer tumour can sometimes block the narrow tube running down the middle of the pancreas (the pancreatic duct), which means that the pancreas enzymes don’t reach the gut to digest food. This can resemble chronic pancreatitis, which is why it’s important to conduct further tests to make a diagnosis.

Diabetes which has developed recently and not linked to weight gain can also be a warning sign of pancreatic cancer. Pancreatic cancer should therefore be excluded by a CT scan in people with new signs of chronic pancreatitis and especially with new signs of diabetes.

How is chronic pancreatitis treated?

Chronic pancreatitis is treated by replacing the enzymes that the pancreas can no longer produce, by taking pills that contain pancreatic enzymes with meals and snacks to help digest the food, controlling diabetes with tablets and/or insulin, and most importantly, trying to make changes in lifestyle that remove the triggers – most importantly alcohol and smoking.

The involvement of a dietician or dietary advice is very helpful: because fat is not absorbed well in chronic pancreatitis, low fat diets can lessen symptoms of malabsorption. Vitamin supplements are often advisable.

Chronic pancreatitis can be painful, so people may need to take medication to manage the pain. Occasionally, pain relief needs to be quite strong.

Surgery for pancreatitis is not done very often and is becoming even less common. Surgery for chronic pancreatitis can help but should only ever be considered after a prolonged period of discussion with specialist pancreas surgeons.

Hereditary Pancreatitis

Rarely, chronic pancreatitis can develop in people (usually young people) who have inherited a faulty gene. When the gene works correctly, it switches off the pancreatic digestive enzymes where and when they are not needed; when it’s faulty this doesn’t happen properly. This is called hereditary pancreatitis.

People with hereditary pancreatitis develop severe chronic pancreatitis which starts at an early age (usually between 5 and 26 years of age,) but can occur at any time. The long-standing inflammation in the pancreas in people with hereditary pancreatitis, and the fact that they may have had it since childhood, means that it is a risk factor for pancreatic cancer